A nurse is caring for a client who experienced a lacerated spleen and has been on bedrest for several days. The nurse auscultates decreased breath sounds in the lower lobes of both lungs. The nurse should realize that this finding is most likely an indication of which of the following conditions?

A. Beginning active range of motion immediately after arthroscopic knee surgery may increase the risk of injury or disruption to the surgical site. Typically, passive range of motion exercises are initiated first under the guidance of a physical therapist or healthcare provider.
B. Remaining on bedrest for the first 24 hours after arthroscopic knee surgery is not typically recommended. Early mobilization and ambulation are encouraged to prevent complications such as blood clots and joint stiffness.
C. Applying ice to the affected area is a common postoperative instruction following knee surgery. Ice helps reduce swelling, inflammation, and pain. It is usually recommended for short intervals, such as 20 minutes every few hours, for the first 48 to 72 hours after surgery.
D. Keeping the leg in a dependent position (hanging down) for an extended period after knee surgery can increase swelling and discomfort. Elevating the leg when resting can help reduce swelling and improve circulation.

Inspection:This is the first step because it allows the nurse to gather information through observation without causing any discomfort to the child. It involves looking at the child's abdomen for any visible abnormalities like distension, asymmetry, masses, or discoloration.

Auscultation:After inspection, the nurse listens to the bowel sounds using a stethoscope. This helps assess peristalsis (movement of food through the intestines) and identify potential problems like bowel obstruction or decreased motility.

Superficial Palpation:This gentle palpation helps assess muscle tone, tenderness, and masses. It's performed after auscultation to avoid altering bowel sounds. Since children are often apprehensive about abdominal exams, starting with a gentler touch can help them feel more comfortable.

Deep Palpation (if necessary):Deep palpation is reserved for last as it can be more uncomfortable for the child. It's used to assess for organomegaly (enlarged organs) or masses that may not be palpable with superficial palpation. It's only performed if there are indications from the first three steps.

Here's a breakdown of why this order is important:

Minimize Discomfort:Starting with non-invasive methods like inspection and auscultation helps establish trust and reduces anxiety in the child, making the overall assessment more cooperative.

Maintain Baseline Bowel Sounds:Palpation can alter bowel sounds, so it's important to listen to them first to get an accurate baseline.

Gradual Progression:Moving from gentle to deeper palpation allows the child to adjust to the sensation and helps the nurse identify potential areas of tenderness before applying deeper pressure.